Permit
i
p CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2010-00015
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/12/2010
Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 180
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: Spec Space
Project Description: Add/alter (4) branch circuits.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 4 crt Branch Circuits 01112/2010 $78.44
wo/Purchase Service or
PHONE: 503-624-6300 Feeder
1 ea 12% State Surcharge - 01/12/2010 $9.41
Electrical
Contractor:
JOHANSEN ELECTRIC INC
10984 SE VALLEY VIEW TERR
HAPPY VALLEY, OR 97086
PHONE: 503-698-3417
FAX: 503-698-2486
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $87.85
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: ~~o~Q'w Q Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
.
Electrical Permit Application E�, ��ED ' € „ i h$ , % nom w , ,. .v _ _, ,.
fir" ui -, s '� . iwrt+ k . "'`' SF .a %�'' ': : : : ,6 z . '��g M . s ',alE',+
Pr?;u 1IIT Received
4 ,' City of Tigard JAN 1 1 2010 nate✓a : ....46 T
• � 25 SW Hall a 1 '31 B lvd ' , T OR 972 Plan Review '
Phone; 503.639.4171 Fat: 503.598.1960 Dato/B Other Permit:
g4 ' r � ,' Insp Line: 503 639 4 175 CITY OF TIGARD Pale Re'adyBY: 61 Se Page .2 for"
' eer €€ 0Y Internet w w tigard or gov - Nou6ed/I Supplemental Infor
, mation
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❑ New construction ❑ Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w/itams Checked MOW):
❑ Service or feeder 400 amps or more ❑Building' over three stor
❑ Demolition ❑Other
where the available fault' current ❑ Marinas and boatyards.
I � i a ' r o g l e t . i , r
. x 'i . �: sl'gti a 1 I i tl Ili � :� IN exceeds 10,m at 11 vo lt s or ing ldga.
€, to do , . . i ..(Millu , 1 -:t , I. . ;.ut: 000 a Ps CI uiin
' b
1 - and 2-family dwelling Less to ground, or exceeds 14,000 0 Commerciai.use agricultural
El y g ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi family ❑ Master builder- . ❑ Other ❑Fire ❑ lnstallationof75 KVA or
larger separately derived sy
tli ,:' €ai t let $a f e 7, B y system., stem • 111 * - 111 . 4 j � . . I s 1 r i t n t a 4 s r i ❑ Addition of new motor load of ❑ 'A ", "g', "1 -2 ", "1.3",
t t,J'ts�:a � .... � ,.ag�,rl r �i (614i
Job no_: Job site address: 12' 9 0 9 SW 6 8 t h , 18 0 I ooHP or more occupancy...
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: ❑ Health -care facilities. ❑ Supply voltage.farmore than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 1 8 0 l Project narn e: vac ci _ n&it ❑ Service or feeder 600 amps or more. _
Cross street/directions to Job site: I''r# ;F trtL <ii1 �h :It ,'Jy .* mss :. ,,�I' I . l �`r
Desertption Ott. Fee. ' Total •
'New single-. or multi - family dwelling unit.
Includes attached garage.
Subdivision: 1 Lot no.: 1,000 sq. ft or less 168.54 4
Tax map /parcel no
Ea add'I 500 sq. fit. or portion 33.92 1
i Limited energy, residential
a w ,: mFM411 -' : 1 . a r�ie r q ^ Tt ,I r .�rr �Y,
' a , I'it ) rei :` ' . : .1 1, gi ' lli a ' (withabwesq.:fl.) 67.84 2
n A trl Limited energy, t o family
�� g 1 1 � 0.1 � l� r i c i 7V V � residential (with above sq. ft:) 67.84 2
Services or feeders installation, alteration, and/or relocation
° 9ta ep s € r 200 amps or less . - 100.70 2
i °i, 7 U u 1�,r; iiii l :' 1 r; 1 t ; i% 1 M. , 1 4 201 amps 'm 400 -amps 133.56 2
Name: • _401 amps _to600 -amps .200.34 2
Address: 601, ampS,to 1,000 amps 301.04 2
'Over •1,000 amps or volts 552.26 2
City /State/ZIP; • Teropgrary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS - 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Owner Signature: Date: Branch circuits — new, alteration, or extension, • s panel
_l !II s to t :. 19�� s, pl ;,,,r a A. Fee for branch circuits with
1, l# , , , h t I Ir ` 1 . t , .
, . i , above service or feeder fee, 7.42 2
each branch circuit
Business name:. Johansen Electric: Inc B. Fee for branch circuits
Contact name: Charlynn eifsen wit o w service or feeder fee,
I
first branch circuit 56-18 (o . {g 2
Address: 10948 SE Valley View Terrace Each add'i branch circuit 3 7.42 1_, Zia 2
Miscellaneous (service or feeder not
City /State/ZIP: Happy Valley, OR 97086 Each manufactured OT modular 67.84 2
Phone: 503 698 -3477 dwelling, service and/or feeder
( ) I Fax: (503) 698 -2486 Reconnect only 67.84_ 2
Email: Pump or irrigation circle 67.84 2
i, - ti tt - '1' .t:t= Si or outline lighting 67.84 2
Business name: Johansen Electric lac Signal circuit(s) or limited-
energy panel, alteration, or
Address: 10948 SE Valley View Terrace extension. Describe: Page 2 2
City/State/ZIP: Happy Valley, OR 97086 Each additional inspection over allowable in an of the above
Per inspection 66.25
Phone: (503) 698 -3417 Fax: (503) 698 -2486 Invests pe
gation" r hour (1 br min) , 66.25
CCB Lic.: 51539 Electrical Lic.: 3 -243C Suprv, Lie.: 2053S Industrial plant per hour . 78
-J f �s e. L _l is �'• 311 i I" ?' 1 . i` e�'yr'a� 3 °. 4;1' �'11V a "�'
Suprv..Electrician signature, required: (^��K. �• �* Subtotal: g , tlt{
Print name: Carl Johansen a 0 II 1 t to Plan review (25% of permit fee):
ffff1111 Y V `-� State surcharge (12% of permit fee): q . y
Authorized signature: y TOTAL PERMIT FEE: lbrl , SS
Print,name:.Charlynn Leifsen Date: 01 11 1 This permit application expires Ha permit is not obtained within 180
r I f days after it has been , aecepted as complete
• Number of inspections allowed per permit.
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